Behavioural Management in Children [Compatibility Mode]

8/12/2019 Behavioural Management in Children [Compatibility Mode]

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Child BehaviourManagement in Dentistry

Dr SUGHU MALAYIL KOSHY

BDS,MSc (Comm.Dent),DDPH RCS(England)


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Categorizing Behavior


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Variables influencing Child behavior:

Parental influences:

Overprotective Parents: Take excessive care of the children.

Such children are submissive , shy & anxious, fear newsituations & lack self confidence

without any restraint. The child becomes spoilt & is used togetting his own way.

Under affectionate parents: Child is devoid of love &affection. Children are shy, indecisive but well behaved.Response when treated with love.


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Authoritarian parents: Try to instill a high level of verbal

discipline in the form of physical punishment & verbalridicule. Such children show a heightened gradient ofavoidance , & try to avoid or delay response

Rejecting parents: Face situation when parents have anunwanted child, unhappy marriage etc. Such children areanxious, overactive, disobedient & most difficult to deal.


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Past Medical & dental influences:

Children who have pleasant past medical experiences aremore likely to be co-operative , & those with experience ofpain & fear will be co-operative.

Home Environment: Home is the first place where the childlearns to behave. Children from broken home will feel

, .

Position of child in the family:First Child- Uncertainty, mistrustfulness, insecurity

Second Child- Independent, Aggressive, ExtrovertMiddle child Aggressiveness, inferiorityLast child Secure, confident, immature, envy


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Sibling Rivalry:

Rivalry & jealousy between siblings for the affectionof parents influence childs behavior.

Socioeconomic status:High authority of parents in low socioeconomicstatus is observed com ared to the medium & the

high

Clinic Set up1. Ambience of the clinic: The clinic environmentshould relax the patient & keep him engaged tilltreatment begins. Should be equipped with toys,playroom, tape recorder, cartoons , Aquarium,

cartoon etc.


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2. Personality of the dentistCasual, confident, friendly, total command of situation, neverloose temper, encourage the child etc.

3. Time & length of appointment:

The duration of appointment should not be more than half anhour.

No appointment to be scheduled during naptime

The appointment to be kept in the morning time

4. Use of Euphemisms (Substitute words)The use of fear promoting words should be avoided . Usesubstitute words that are less provoking. Eg: Needle prick as

a mosquito bite


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5. Use of flattery , Reward & praise

The use of Tiny gifts, after the treatment have a greatinfluence on the child's behavior. Praising a child or a patthe back helps him/her to gain confidence

6. Parent counseling: The parents should keep the followingpoints in mind.

1. Not to voice their own fears2. Not to use dentistry as a threat3. Mothers presence reduces the fear of the child


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Behavior Management

Behavior management can be 2 types:

Non-Pharmacologic Behavior management

armaco og c e av or managemen


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Non Pharmacologic Behavior management:

Communicative Management:

Most basic form of behavior management & first step in

treating the child.

The objective develop rapport with the patient & gain trust

The types of communication include:

Verbal

Non verbal may be in the form of patting, smileacknowledging good behavior


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2.Systematic Desensitization:

Involves gradual exposure of the child to least stressful objectsto the most stressful object.

Done in 2 steps:

1.Grad al ex os re of he child o his or her fear

2.Induced state of incompatibility with his or her fear

3.Tell Show do (TSD)Dentist first explains to the patient in easy terms (Tell)

Demonstrates procedure to the patient . Eg: using mouth mirroror probe.

Continues with performing the procedure (Do)


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TELL SHOW DO


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5. Voice Control:

Controlled alteration of voice volume. Allows dentist toinuculate more authority into his/her communication.

It must indicate that I am in charge here (facialexpressions have an important role to play

.Its a method where a childs behaviour is altered bypresenting or withdrawing a reinforcer.

Positive reinforcement: childs behaviour is encouraged orpraised by patting on the back.Negative reinforcement: Withdrawing a toy from the child

on performance of an undesirable behaviour


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7.Hypnosis:

Helpful in reducing anxiety & increasing pain threshold

It is an altered level of consciousness characterized by a

heightened suggestibility to produce desirable behavioral &physiological changes

.

Techniques used in the management of non-cooperativechildren

They are physical restraints & HOME. Consent is necessaryfor these procedures


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They include active & passive. Divided based on the area ofuse:Body- Papoose board,pedi wrap

Extremities- Velcro straps, bean bagHead- Head positionerMouth- Bite blocks, props

Physical Restraint:

t ers, eg: c a r straps

2. Hand Over Mouth Exercise (Levitas 1974)

Gain attention of highly co-operative child who is not willingto receive any sort of communication from dentist

Not be used for children above 4-6 years of age or who do

not have any handicapping conditions


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Papoose board restraint


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A hand is placed over the childs mouth & behavioral

expectations are explained. The hand is removed orreapplied depending on the behavior of the patient

Use of HOME is indicated for a healthy child who is able to

understand & co-operate but exhibits defiant or hystericalavoidance behavior.

s contra n cate t causes occ us on o nasapassages & restricts breathing, unable to obtain informedconsent, unable to understand & co-operate due to age,disability or medication.


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Pharmacologic Behavior management (Conscious

sedation & General anesthesia)

Used only when the patients lack co-operative behavior or asystemic condition requires it.

Conscious Sedation:

patients ability to maintain an airway independently & respondappropriately to physical stimulation & verbal command (ADA1993).

Useful for nervous & apprehensive child requiring extensivetreatmentNitrous oxide oxygen combination is the drug of choice


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Conscious sedation


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GENERAL ANESTHESIA:

Patient is unconscious & unable to maintainrespiration independently & loses all protective reflexes.

Indicated when the patient is mentally or physically

handicapped, too young to co-operate

All other behavioral management technique has failed

Patient requiring extensive/immediate dental treatmentwhich would otherwise require multiple appointments


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Contraindications indicate systemic conditions where

use of anesthesia is not advisable. In both conscioussedation & general anesthesia written parental consentis a must


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Behavioural Management in Children [Compatibility Mode]

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